1. C21 Epilepsy and Seizure Disorders

2. Overview Define Epilepsy Identify Different Types of Seizures
Diagnosing Epilepsy
Discuss Treatment Options
Prognosis
Living with Epilepsy

3. Epilepsy
A neurologic disorder resulting from an abnormality of the brain and ends up causing a specific type of seizure
It can affect anyone of any age group and will cause a change in behavior
Epilepsy cannot be prevented, but there are ways to living a healthy, adequate life with this disorder

4. Different Types of Seizures
Generalized clonic-tonic (Grand-Mal)
Absence (Petit-Mal)
Partial (Focal)

5. Different Types of Seizures Generalized clonic-tonic (Grand Mal):
This type of seizure is more violent when observing signs and symptoms. It can be identified when the individual is hypersalivating (foaming at the mouth), loss of muscle control, has loss of consciousness and unable to control urination and defecation.
During a Grand-Mal seizure, respirations may cease due to the tonic spasm of the diaphragm muscle and the patient can become cyanotic from lack of breathing.
As a result, the patient will most likely go into a postictal state after seizing, wake up in a confused mental status and may not recall what just happened.
Postictal state can range anywhere from minutes
Different Types of Seizures Generalized clonic-tonic (Grand Mal):

6. Different Types of Seizures Absence (Petit-Mal):
This kind of seizure is harder to recognize with the specific signs it has. For the observer, the patient may look as though they are daydreaming or absentmindedness.
More common in younger children, usually no earlier than the age of four and no later than ages of puberty.
A good sign to tell if someone is having a Petit-Mal seizure is if they suddenly stop talking or responding while looking off into the distance. Another symptom is a rapid movement of the eyelids, fingers or facial muscles.
Unlike Grand-Mal seizures, with Petit-Mal seizures the patient will usually return to normal activity or behavior after seizing.
Different Types of Seizures Absence (Petit-Mal):

7. Different Types of Seizures Partial (Focal):
Focal seizures affect the contralateral side or one side of the body (only one specific part of the brain) and have the potential to damage the patient’s speech, language and certain areas of movement in the body.
With Focal seizures, it is important to understand, one may not tell when an individual is having this type of seizure because they can be fully aware while seizing.
Different Types of Seizures Partial (Focal):

8. Diagnosing Epilepsy Electroencephalogram (EEG *most common)
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI *gold standard)
Positron Emission Tomography (PET)

9. Electroencephalogram (EEG *most common)
Small metal wires are attached to the scalp where the device measures electrical brain activity
Not all EEGs are accurate, findings from this test may present as normal in 55 percent of patients who have epileptogenic lesions

10. Computed Tomography (CT)
Abnormal CT contrast enhanced scan of the brain with seizure activity involving the left cerebral hemisphere.
Better visualization and demonstration of hard and some of the soft tissues in the cranium
If CT results come back as negative or undetermined, MRI imaging may be required

11. Magnetic Resonance Imaging (MRI *gold standard)
High resolution that can detect underlying abnormalities in the brain and the diagnosis of epilepsy
MRI can detect changes in white matter of the brain that occur usually after withdrawing of an antiepileptic medication, along with any cerebellar signal changes after a seizure

12. https://encrypted-tbn0. gstatic. com/images
MRI of the brain. Image to the left shows a normal brain and tissues. Image to the right demonstrates abnormal tissue on the left side of the brain as a result of seizure activity.

13. Positron Emission Tomography (PET)
Use F-Fluorodeoxyglucose to trace metabolic activity or detect malignant tissues
PET scans are more sensitive by percent and have a low percentage of false- positive results
PET scan of the brain. The image to the left shows a normal brain with the radioactive tracer material. The image to the right visualizes damage to the right side of the brain as a result of seizure activity.

14. Ways to Treat Epilepsy
Prescribed anticonvulsant medications *most common
Different medications for the certain type of seizure
Vagus Nerve Stimulator (VNS) device implant
Natural Remedies:
Cannabidiol (CBD) oil
Keto diet
Surgery

15. Prescribed anticonvulsant medications *most common
For Grand-Mal and Petit-Mal seizures, medications commonly used are valproic acid (Depakote®) and phenytoin (Dilantin®)
For Partial (Focal) seizures, medications commonly used are called levetiracetam (Keppra®) or oxcarbazepine (Trileptal®)
The goal of these types of medications are to reduce or eliminate the number of seizures

16. Vagus Nerve Stimulator (VNS) Device Implant
Implanted into the chest wall and electrodes stimulate the vagus nerve at the left carotid bifurcation to help reduce the amount of seizures
This device can last anywhere from three to eight years and will not interact with any other medications

17. Natural Remedies Cannabidiol (CBD) oil: Keto Diet:
Is administered to epileptic patients in an encapsulated gelatin capsule that is taken orally
CBD oil causes less adverse effects compared with traditional AEDs, because cannabis products are derived from natural sources and are unlikely to be harmful
Keto Diet:
Due to research, being on the diet could reduce the amount of anticonvulsant medications

18. Surgery
Able to remove abnormal brain cells that are creating the seizures for those who have chronic epileptic seizures, lesions or tumors from traumatic brain injury
Typically surgery is the last option due to it being an invasive procedure and the risks for the patient. Risks include but are limited to:
Infection
Brain bleeds
Death, in rare cases
Surgical procedures for epileptic patients have been proven to be successful long term

19. Prognosis of Epilepsy Little is known when it comes to life expectancy
If a patient has a seizure that lasts longer than 5 minutes, the mortality rate can increase substantially
Sudden unexpected death in epilepsy (SUDEP)
Those with idiopathic epilepsy (Grand-Mal seizures) have a life expectancy up to 2 years shorter
Prognosis of Epilepsy

20. Living with Epilepsy Avoiding triggers that set off seizures such as;
Bright, flashing lights
Drug and/or alcohol abuse
Loud noises
Stress and lack of sleep
Life long condition that can be controlled by certain methods
In some cases, a healthy diet and exercise are beneficial
Those with epilepsy can lead normal lives
May have limitations
Examples include; driving, swimming, etc.

21. Facts/Statistics of Epileptic Disorder
3 million adults and 470,000 children have epilepsy in the US
There is no cure currently for epilepsy
Epilepsy is most commonly diagnosed in people under 20 and people over 65
Roughly, 1 out of 26 people in the U.S. may have a seizure during their lifetime
November is National Epilepsy Awareness Month

22. Epilepsy Recap Click on any topic to go back to that slide
Different Types of Seizures:
Generalized clonic-tonic (Gran...
Absence (Petit-Mal)
Partial (Focal)
Diagnosing Epilepsy:
Electroencephalogram (EEG *most common)
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI *gold standard)
Positron Emission Tomography (PET)
Ways to Treat Epilepsy:
Prescribed anticonvulsant medications *most common
Vagus Nerve Stimulator (VNS) Device Implant
Natural Remedies
Surgery
Prognosis of Epilepsy
Living with Epilepsy
Facts/Statistics of Epileptic Disorder

23. References
Hinners J. Epilepsy and Magnetic Resonance Imaging. American Society of Radiologic Technologists. 2018;89(5):
Eisenberg RL, Johnson NM. Epilepsy and Convulsive Disorders. Comprehensive Radiolograhic Pathology. 6th ed. St. Louis, MO: Mosby Inc.; 2016:
Rodriguez D. Preventing Epilepsy Seizures. EverydayHealth.com. Published February 21, Accessed October 14, 2018.
Living with Epilepsy. Epilepsy Foundation. Accessed March 9, 2019.
Epilepsy Awareness Month. EFEPA - Epilepsy Foundation Eastern Pennsylvania. Accessed March 9, 2019.